Viewpoint: Public Good vs. Property Rights

Balancing community values with individual values is one of the most challenging aspects of developing public policy. The noble views one might have from a community perspective do not always hold firm when the implementation of public policy begins to affect the lives of individual people in the community. Recognizing this reality and using it early on to help shape the public policy debate benefit all public health practitioners.

History has many lessons about potential conflicts between community and individual values. For example, take the experience of Edwin Chadwick, who lived in England in the early 1800s. One of the founders of public health, his observations of poor sanitary conditions and their relationship to community health led to the adoption of one of the first comprehensive public health laws of the time, the Public Health Act of 1848. Chadwick's passion and drive brought significant improvements in the living conditions in England over the following few years, resulting in improved health status of the community. However, although reaping benefits from these improved community conditions, many people were still not ready for the degree of change being imposed on them by the new public health law. The Times, which had originally supported the Public Health Act, captured their emerging sentiment in this quote: "…we prefer to take our chance of cholera and the rest than be bullied into health." In 1854, under pressure from the community, the Public Health Act was repealed. Such a landmark public health law was not to be seen again for years.

This conflict between community values and individual values is as much alive today as it was in the 1800s. The field of drinking water protection, where I now work, is full of prime examples of these conflicts. Take for example the current dilemma faced by the U.S. Environmental Protection Agency as it struggles to set a new drinking water standard for arsenic. On the broad community level few want to see arsenic, at any level, as a contaminant in their drinking water supply. Yet as the individual members of a community discuss and realize the costs of treating water to achieve a standard of only a few parts per billion of arsenic, a whole new set of values gets imposed on the debate.

Another example of conflicting community and individual values comes from my experience dealing with a ground water protection initiative in a local community in the 1990s. The community's interest in maintaining and protecting high quality ground water resources could not have been clearer. Community meetings and surveys reflected the high value the community placed on clean drinking water supplies. Ultimately, an Aquifer Protection Area ballot measure was placed before the voters asking for a funding package totaling twelve dollars a year per residence for future ground water protection activities. The vote turned out decidedly negative, as the voters rejected any level of funding for these protection-oriented activities. The most negative comment heard about this measure was "I can't see what I would personally get for my one dollar per month."

Recognizing and addressing such conflicts in values is a significant challenge for public policy makers, particularly in the environmental health field as we continue to refine our analytical abilities to detect contaminants at lower and lower levels. The implications of the information we gain from this evolving capability are not always clear. It is often difficult to quantify or characterize the health risks objectively. The goal of creating a "risk-free" environment for a community is very often at odds with the ability of the individuals in that community to implement and pay for potential interventions. We will continue to be pressed to recognize and balance broad community values for health protection with individual values related to personal priorities and government interventions. As public health professionals, we are seldom able to resolve this conflict, but we can approach issues more productively if we at least understand the conflict and help others to do the same.

Gregg Grunenfelder, MPH, is director of the Division of Drinking Water for the Washington State Department of Health and current president of the Association of State Drinking Water Administrators.